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Article
Clinically Isolated Syndrome of Early Onset Multiple Sclerosis in a Sample of Iraqi Patients

Author: Hasan Azeez Al-Hamadani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 397-401
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The first acute demyelinating event without encephalopathy, termed a clinically isolated syndrome, can manifest with signs and symptoms caused by a single lesion (monofocal clinically isolated syndrome) or with polyfocal features, implicating multiple lesions. It is becoming increasingly recognized that MS affects children and adolescents, with many of these patients receiving the diagnosis and initiating therapy prior to their 18th birthday(2).OBJECTIVE:To evaluate the clinically isolated syndrome in individuals with early onset of multiple sclerosis.MATERIALS AND METHOD:The records of the multiple sclerosis centers in Baghdad teaching hospital have been surveyed. The study enrolled 77 patients who had early multiple sclerosis (onset before age of 18 years), their clinically isolated syndrome data have been analyzed.RESULTS:Two thirds of the patients were female (a female/male ratio of 1.6:1). Forty eight of the patient where female (62.3%) and twenty nine patients where males (37.7 %). Mean age at onset was 14.95 years. Seven patients where children (age below 10years) (9.1%) and seventeen patients where adolescents (age 10 to 18 years) (90.9%) at onset. The most common presenting clinically isolated syndrome was optic neuritis (35.8%) followed by brain stem lesion. Fifty nine patients had monofocal presentation (76.6%) and eighteen had polyfocal presentation (23.4%). forty seven patients had complete improvement of the clinically isolated syndrome (61.0%), the rest had partial or no improvement.CONCLUSION:The most common clinically isolated syndrome of early onset Multiple sclerosis is optic neuritis. monofocal clinically isolated syndrome more than polyfocal. Complete improvement is high.


Article
The Role of Gender in Early Onset Relapsing Remitting Multiple Sclerosis

Author: Hasan Azeez Al-Hamadani
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 250-257
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Multiple sclerosis is an autoimmune inflammatory demyelinating disorder of the central nervous system. Multiple sclerosis is now universally found to be more prevalent in women than menOBJECTIVE: The aim of the study is to clarify the role of gender in early onset multiple sclerosisPATIENTS AND METHODS: This retrospective study was conducted in the multiple sclerosis clinic archive system in the Medical City Hospital in Baghdad, Iraq. Data collection was carried out between March 2008 and March 2009. The patients diagnosed to have relapse remitting multiple sclerosis according to the revised McDonald’s diagnostic criteria for multiple sclerosis, and onset of disease must be before the eighteenth birthday. For each patient, the following information was gathered: age, gender, date of onset, and date of second attack, presenting symptom, and extended disability status scale and the date, and type and location of MRI lesions. A p-value <0.05 was considered the cutoff point to determine significant findings. RESULTS: Forty-eight of the patients where females (62.3%) and 29 patients where males (37.7%), with a female: male ratio 1.6:1. No significant difference was found regarding distribution of gender in each age group, and no significant difference was found when age at onset was compared between males and females, although in male patients a shift to children and a shift at adolescence in female were observed The comparison of different radiological sites between males and females shows a significant difference with more males having infratentorial lesions compared with females (P=0.033). No significant difference was found between the two genders regarding, age at onset the presenting symptom, mode of onset and no significant difference was found when interval between the first and second attack was compared between males and females. CONCLUSION: Female preponderance was highest for subjects with disease onset at adolescents. No significant difference was found when age at onset was compared between males and females, although in male patients, a shift to children and a shift at adolescence in female were observed. A significant difference in the time, between first and second attack between males and females. A significant difference in the MRI findings was the finding that males had a higher incidence of infratentorial lesion than females.


Article
The Prevalence of Dysautonomia in Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Authors: Hasan Azeez Al-Hamadani --- Muhannad kamil hamid --- Basheer Hussein Salman
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 1 Pages: 1-6
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT :BACKGROUND: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), an immune-medaiated disorder of peripheral nerves and nerve roots. Dysautonomiais has not been studied deeply and many question not answered.OBJECTIVE:To estimate the prevalence of dysautonomia in chronic inflammatory demyelinating polyradiculoneuropathy in a group of Iraqi patients .METHODS:A cross sectional study of 23 patients fulfilled the diagnostic criteria for definite chronic inflammatory demyelinating polyradiculoneuropathy underwent autonomic function in cross sectional study which has been done in Al-Imamain Al-Kadhmiyain Medical City from December 2008 to November 2010 to detect any abnormalities in sympathetic and parasympathetic autonomic nervous systems tests. RESULT: This study includes 23 patients diagnosed with CIDP, 12 patients (52%) were male and 11 patients (48%) were females. Twenty patients had autonomic dysfunction, either clinical or subclinical or both.Eighteen of 20 patients (90%) had abnormal autonomic function tests, 16 of 20 patients (80%) symptomatic, and 14 of 20 Patients (70%) symptomatic with abnormal autonomic function tests. Abnormal autonomic function tests were found in 18 of 23 patients with CIDP (78%). In 8 patients (44%), abnormal results were limited to parasympathetic function test. Five patients (28%) abnormal results were limited to sympathetic function test. Five patients (28%) exhibited dysfunction in both systems.CONCLUSION:The findings in this study suggest high frequency of clinical and subclinical dysautonomia and parasympathetic system more likely affected than the sympathetic nervous system in patients with chronic inflammatory demyelinating polyradiculoneuropathy.


Article
The Potential Effect of Lipid Profile on Deep Seated Versus Lobar Intracerebral Hemorrhage

Author: Saif M. Tawfeeq*, Hasan Azeez Al-Hamadani**, Munther Taher Hamzah***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 1 Pages: 57-63
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Brain hemorrhage is defined as the extravasation of blood from the vascular bed into the intracranial space, resulting in clinical dysfunction of nervous system. Intracerebral hemorrhage is a heterogeneous disease with deep and lobar subtypes. The amount of serum lipid may also affect the integrity of blood vessel wall and abnormal lipid profile may consider as a risk factor for intracerebral hemorrhage.OBJECTIVE: The present study was designed to evaluate the relationship between serum lipids and the site of intracerebral hemorrhage.METHOD: A cross-sectional study for 100 patients (50 with deep seated, 50 with lobar intracerebral hemorrhage) from Al-Kadhymia teaching hospital and Bagdad Teaching Hospital between August 2012 and June 2014. Case subjects included those patients from 20 to 89 years of age experiencing ICH within first 48 hours of presentation. Total cholesterol (TC), High-density lipoprotein (HDL) cholesterol, Low-density lipoprotein (LDL) cholesterol and Triglycerides (TG) serum level, was compared in deep seated and lobar intracerebral hemorrhage.RESULTS: There was significant relationship between high HDL level in deep seated compared to lobar hemorrhage, while there was no statistical significant relationship between the site of hemorrhage by TC, LDL and TG levelCONCLUSION: High HDL level is a risk factor for deep seated rather for lobar intracerebral hemorrhage.TC, TG, LDL have no effect on the site of hemorrhage.


Article
Normative Data of Needle Electromyography, What Is Different in Iraqi Patients

Authors: Hasan Azeez Al-hamadani --- Zainulabdeen Abdulsamad Mahdi --- Farah Al-Saffar --- Atheer Sabah Fayahd
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 496-502
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The electrodiagnostic studies are useful adjuncts to the clinical examination of the peripheral nervous system. Electromyography (EMG) records the physiologic status of muscle function. Needle electromyography help localize abnormalities along peripheral nerves or lower motor neurons.OBJECTIVE:To establish the normal electrophysiological values of the common upper and lower limbs muscles in sample of healthy adult population in Iraq using standard temperature control, and to compare with those data published in other studies.MATERIAL AND METHODS:This is a cross sectional study conducted in Al-Kadhmiya Teaching Hospital during the period from July 2008 to December 2009. The study included 43 healthy individuals, aged 20-50 years (15 women and 28 men). Using the standardized technique, underwent electrophysiological studies for EMG studies for the commonly tested muscles.RESULTS:Forty-three individuals (include15 women and 28 men) participated in the study, and conventional EMG successfully done with good cooperation. EMG parameters results corresponded with those previously published in other studies.CONCLUSION:This study helps establish the normative electrophysiological parameters of the commonly tested muscles in the upper and lower limbs for our EMG laboratory in Iraq. The results compared favorably with existing literature data.

Keywords

electromyography


Article
RHEUMATOLOGIC COMPLICATIONS OF SHOULDER JOINT AFTER STROKE
ألام الكتف عقابيل الضربة (الجلطة) الدماغية

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Abstract

Background: Shoulder pain is one of the complications that happened in patient suffered from hemiplegia. There are many pathological processes have been postulated as causes of painful hemiplegics shoulder after stroke. One of the causes is Rotator cuff syndrome. Other causes of shoulder pain are biceptal tendonitis; Subacromial and sub-deltoid Bursitis, Adhesive capsulitis (frozen shoulder) is a common painful condition associated with loss of active movement in the direction of external rotation and abduction.Objective: The aim of this study is to analyze shoulder pain and its correlation with the different clinical aspects of cerebral dysfunction. Patients and method: 56 patients affected by different types of stroke were enrolled in this study , each patient was examined by neurologist, CT scan then done and referred to a consultant rheumatologist at Al-Kindi hospital for assessment of his shoulder area, the patient then investigated thoroughly for his or her shoulder pain. Results and conclusion: The study showed high correlation between shoulder pain and older age patients, aphasia, cortical sensory defects. The shoulder pain development is more common in older age group. Patients with cortical involvement are at high risk to develop shoulder pain. The shoulder pain development is not related to the side of hemiplagia, sex and grading of muscle weakness.

خلفية الدراسة: ألم الكتفِ أحد التعقيداتِ التي تحَدثْ في مرضِى الجلطة الدماغية.هدف الدراسة: إنّ هدفَ هذه الدراسةِ أَنْ تُحلّلَ ألمَ الكتفِ وإرتباطِها بالسماتِ السريريةِ المختلفةِ للجلطة الدماغيةِ.طريقة العمل: اجريت الدراسة على 56 مريض مصا ب بالجلطة الدماغية بنوعيها ا لنزفي و الفاقة الدموية(17).اشتكى هولاء المرضى من الم في الكتف في الجهة المصابة بالشلل. 29 مريض مصاب بالجلطة الناتجة عن الفاقة الدموية و 27 بالجلطة النزفية, تتراوح اعمار المرضى بين 23-73 سنة .النتائج: تبين من خلال الدراسة وجود ارتباط مهم احصائيا بين الام الكتف مع تقدم العمرو مع اضرار الحسية المركزية(عدم التمييز باللمس وعدم الاهتمام الحسي و عدم تحسس الرسم فى الكف)(17) واصابات النطق اللغوية(الخرس)(17) .فيما لم تثبت علاقة احصائية مع نوع الجنس و جهة الاصابة الدماغية و كذلك مع نوع الجلطة . اثبتت الدراسة ان تجمد الكتف(الالتصاقية المحفظية للكتف)(17) هو السبب الاكثر ظهوراً خلال هذه الدراسة .الإستنتاج: خرجت الدراسة بنتيجة الاهمية الكبيرة للاهتمام بالاصابة بالام الكتف لما لها من تأثير سلبي على اعادة تأهيل المريض . و تنصح الدراسة بمشاركة اختصاص امراض المفاصل و التأهيل الطبي منذ الايام الاولى للاصابة بالجلطة الدماغية لغرض منع الحالة و تقليل اثارها السلبية


Article
CARRIER DETECTION OF DUCHENNE MUSCULAR DYSTROPHY BY CPK ACTIVITY TESTING AND CONVENTIONAL NEEDLE EMG
اكتشاف حاملات مرض دوشن العضلي بفحص فعالية أنزيم CPK مع تخطيط العضلات التقليدي

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Abstract

Background: Duchenne Muscular Dystrophy (DMD) is a dismal disease, which exhibits an X-linked mood of inheritance, characterized by progressive proximal muscular weakness, beginning in early childhood, wheel chair dependency by early teens and death from cardiopulmonary complications by the end of the second or third decade. Although the majority of carriers of DMD and Becker muscular dystrophy (BMD) are asymptomatic but they can be identified through minor clinical changes like limited weakness or occasionally bulky calves, and some may have elevated CPK levels and mild EMG changes, and as DMD is incurable disease, and carrier detection and genetic counseling are an important aspect of the global approach to limiting the number of patients with DMD and BMD and of carriers.The Objective of the study is to test the value of CPK and conventional needle EMG muscle testing in detecting carriers in a group of Iraqi females with their sons having DMD and BMD.Patients and Methods: The study was conducted in AL-Kadhimiya Teaching Hospital Section of Neurology from October 2002 to December 2003, where a group of 20 female carriers of DMD and BMD, from 15 families were studied and compared to other Control group of 20 females randomly picked up. To each female studied full medical history, neurological examination, including manual muscle power testing, and Pedigree analysis taken, and to each female in the study CPK testing, ECG, with cardiac Echo, and Conventional needle EMG were done.Results: Only one female carrier (5%) had mild proximal muscle weakness, cardiac involvement only one (5%), had mildly dilated left ventricle but with normal systolic function.11 (55%) female carriers had mildly elevated CPK above the upper reference range (170 U/L); 10 (58.8%) DMD, and 1 (33.33%) of BMD. And there is significant (p<0.05) difference in CPK activity between the two groups.There is negative correlation between the age of female carriers and the CPK activity.9 female carriers (45%) total, (52.94%) of DMD had proximal myopathic EMG changes, which were more prominent in the upper limbs. And there is significant (P< 0.05) difference in mean amplitudes of motor unit action potentials of Biceps Brachii, and Vastus Medialis muscles. Conclusion: As the CPK and EMG testings are simple, non costly and readily available tests, and as they can be positive to some extent in a proportions of carriers so they can be performed on all possible carriers in the families of DMD & BMD as a simple screening test, especially the CPK, better to perform at an earlier age, and the EMG at an older age because it requires cooperation.This has a significant impact on genetic counseling, aiming at preventing the spread of this bleak disease.Keywords: Duchenne, Becker, Musclar dystrophy, Female carriers, CPK and Conventional EMG.

خلفية الدراسة: أن مرض دوشن العضلي هو مرض مغم ذو وراثة مرتبطة بالكروموسوم xالأنثوي , ويتسم بضعف عضلي في العضلات الهيكلية القريبة بصورة متفاقمة بدءا من الطفولة المبكرة مرورا في مرحلة المراهقة حيث يكون المريض مقعدا والموت نتيجة العجز التنفسي بنهاية العقد الثاني أو الثالث . بالرغم من إن غالبية حاملات مرض دوشن أو بيكرالعضلي غير ظاهرة عليهم أعراضه لكن بالإمكان معرفتهم من خلال التغيرات السريرية الطفيفة مثل الضعف العضلي المحدود أو بروز عضلات الساق أحياناً بينما نجد لدى بعضهن ارتفاع معدل فعالية الأنزيم العضلي CPK و تغيرات طفيفة في التخطيط العضلي.ويعتبر مرض دوشن العضلي غير قابل للشفاء في الوقت الحاضر ولحد الآن اكتشاف حاملات المرض والاستشارة الوراثية يعتبران من الجوانب المهمة في الطرق الشاملة لتقليل عدد مرضى دوشن و بيكر العضلي و حملاته.هدف الدراسة: من هذه الدراسة هو لاختبار قيمة الأنزيم العضلي CPK و تخطيط العضلات التقليدي لأكتشاف حاملات المرض في مجموعة من الأمهات العراقيات لمصابين بمرض دوشن و بيكر العضلي.المرضى والطريقة: تمت هذه الدراسة في مستشفى الكاظمية التعليمي / قسم طب الجملة العصبية للفترة المحددة بين تشرين الأول 2002 إلى كانون الأول 2003 تمت خلالها دارسه 20 إمرأه حاملة لمرض دوشن و بيكر العضلي , من خمسة عشر عائلة ( ثلاثة عشر عائلة دوشن و عائلتان بيكر) وقد تمت مقارنة النتائج لمجموعة أخرى مكونة من عشرين أمرأه تم جمعها عشوائيا.لكل إمرأه مشتركة في الدراسة تم أخذ التأريخ المرضي و الفحص السريري الكامل بضمنها فحص قوة العضلات اليدوي وتم دراسة و تحليل شجرة العائلة , وتم أخذ نماذج من الدم الوريدي لفحص معدل الأنزيم العضلي CPK , وتخطيط القلب ,فحص القلب بالموجات الصوتية و تخطيط العضلات التقليدي .النتائج: وجد أن حاملة واحدة فقط (5%) عندها ضعف بسيط في العضلات الهيكلية القريبة .وفيما يخص شمول القلب كانت النسبة ضئيلة جدا هو مريضة واحدة فقط ( 5% ) عندها توسع بسيط في البطين الأيسر للقلب ,.أحدى عشر امرأة ( 55% ) حاملة وجدت لديها ارتفاع معدل الأنزيم العضلي CPK و بأهمية إحصائية.وقد لوحظ وجود علاقة سلبيه بين عمر المرأة الحاملة للمرض و معدل الأنزيم العضلي CPK .تسعة حاملات لمرض دوشن العضلي ( 52.94% ) وجدت لديها تغيرات أعتلالية عضلية في العضلات الهيكلية القريبة في فحص تخطيط العضلات وكان هذا جليا في عضلات الأطراف العليا وهو أيضا بأهمية إحصائية .الإستنتاج: بما أن أنزيم أل CPK وتخطيط العضلات التقليدي هما من الفحوصات البسيطة وقليلة التكاليف ومتوفرة وتكون موجبة الى حد ما في نسبة من الحاملات لذلك يمكن استخدامها لكل الحاملات المحتملين في عوائل لمرض دوشن و بيكر العضلي كفحص استبياني بسيط . وخصوصا فحص أل CPK يفضل أجراءة إلى عمر مبكرة و فحص تخطيط العضلات لعمر أكبر وذلك لتطلبه قدرا من تعاون المريض. وهذا له وقع مهم على الاستشارة الوراثية هادفا لمنع انتشار المرض. مفتاح الكلمات: دوشن وبيكر العضلي ، الحاملات ، أنزيم cpk ,تخطيط العضلات التقليدي.

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